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In followup to our discussion with Jim Manning MD (@JManning_UNC) and Lionel Lamhaut (@LionelLamhaut) MD of the Service d’Aide Médicale Urgente (SAMU) for EDECMO Episode 25, the guys spent the last few days ‘just hanging out in Paris.”
The recent massacre in Paris certainly makes this topic..well…topical.
Manning spent several days with the prehospital ECMO team in France. In this episode Zack interviewed Manning, who was on-location with the SAMU in France…and walks us through the experience of witnessing prehospital ECMO with the SAMU.
In the U.S., we aren’t yet ready for pre-hospital endovascular resuscitation – indeed there are currently several barriers to overcome. But perhaps the Europeans are onto something here:
Femoral cutdown vs. percutaneous access? Discussed. Verdict?
Transporting a patient on ECMO:
You know, the thing is…that once you have a patient on ECMO, everything chills out…
-Jim Manning
Every patient gets:
- Dobutamine: 5 ug/kg/min
- Norepinephrine 3 mg/hr
- pRBC 2 units
- FFP 2 units
Flow goals: start 2.5-3 lpm…then slowly increase. Does this help quell reperfusion injury?
This is the exciting. This is fantastic. This is the future if you ask me. We are going to be doing this and its just a matter of time before the rest of us realize that…we are headed in the right direction
I think ED ECMO is a good idea, I also believe that ECMO will become the new ventilators of the future. As mentioned in this article, this idea has just not caught on yet in the US
Thanks for the comments. ECCO2R may be a viable alternative to, or in addition to, ET Ventilation. Smaller cannulae would be a nice addition. To be able to put in a 12Fr (or even better 9Fr) line and be able to do CO2 removal is an interesting possible future mainstay.